Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate

Abstract

The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n\u2009=\u200949) or LP (n\u2009=\u200950). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (±\u200913.3,, and the mean follow-up was 66 months (±\u200913.5). At last follow-up, VAS was lower in the IMN group (0.9 (±\u20091.1) vs. 1.9 (±\u20091.7), p\u2009=\u20090.001). The median Constant score was significantly higher in the IMN group (81.6 (±\u200910.9) points) vs. in the LP group (75.6 (±\u200919.5) points) (p\u2009=\u20090.043), and ASES score was also significantly higher in the IMN group (86.3 (±\u20099.5) vs. 75.2 (±\u200919.6), p\u2009=\u20090.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p\u2009=\u20090.003). Revision surgery was higher in the LP group (37% vs. 21%). Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.